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How to Manage Stress, Anxiety and Depression | BU Today


Behavioral Medicine director offers advice for students, parents

As the Class of 2023  settles in on campus, BU Today offers a series called “Campus Life 101.” You’ll find tips about how to shop for groceries, what to look for when buying backpacks, how best to manage your personal finances, how to stay safe on—and off—campus, and how to reduce stress and anxiety.

Starting college can be stressful. For many freshmen, it’s the first time they’ve lived away from home. They’re learning to live with strangers, adjust to a new environment, carve out an identity on a BU campus of 30,000 people. For many, add in battling homesickness.

And it isn’t just freshmen who are dealing with stress. The stress levels of all college students have been on the rise. The American College Health Association 2019 National College Health Assessment reports that 45.3 percent of students said they had experienced “more than average stress” in the last 12 months, 13.4 percent reported feeling “tremendous stress” during that time, and 22.1  percent said they felt overwhelming anxiety at some point in the past year. The same study found that among BU students specifically, 59.4 percent reported experiencing “more than average stress” or “tremendous stress” during that time and 23.8 percent reported feeling overwhelming anxiety. Statistics like these are familiar to Carrie Landa, the director of Behavioral Medicine at Student Health Services (SHS). Landa says that the growing number of students feeling stressed translates to an increased demand for mental health and counseling services at college campuses across the country. During the 2018-2019 academic year, Behavioral Medicine had 15,847 visits from students, up from 13,296 visits the year before. The visits included initial assessments, follow-up appointments, group visits, and emergency visits. 

For the majority of students, stress and anxiety don’t get in the way of living a productive daily life. But “when stress becomes distress,” Landa says, it’s time to reach out for help.

We spoke with Landa about tips for handling homesickness, common stress, and anxiety, the warning signs that a student may be experiencing something more serious, and the mental health services available at BU.


With Carrie Landa

BU Today:It’s not unusual for new students to feel homesick during the first weeks of school. How do you suggest they cope with those feelings?

Landa: Students should know that it’s okay to feel sad and homesick, but it’s also okay to enjoy your new life at BU. If you focus too much on what life was like in high school, you won’t have enough energy to start your new life in Boston. Try to schedule specific times to talk with your friends and family rather than texting or calling them throughout the day. Think about other times when you’ve been away from home and what helped you get through. Remind yourself of all the reasons you chose to study at BU and try to look forward to the new experiences ahead. If you are feeling homesick, you are not alone. Reach out to others in your dorm and talk to your RA, who is a great resource for finding out about campus activities. And try to make your new home truly comfortable, combining items that remind you of your family and friends back home, but also celebrate being at BU.

Are stress and anxiety common in freshmen?

With each academic year, different stressors may occur. For freshmen, it’s the transition from home to college, adjusting to managing the majority of things for themselves. For some, the anxiety is specifically related to social relationships and finding a social group that feels anchoring. Researchers say that many students who feel separation anxiety invest a lot of time trying to maintain ties with high school friends, which in turn prevents them from investing in new friendships at college. Recognizing that there are approximately 3,200 other freshmen at BU in the same position may make it feel less overwhelming.

For some new students, it is also a significant change in pace to be living in a city and managing things like laundry, an eating schedule, and the self-discipline to go to sleep at a reasonable hour or wake up early enough. Transition issues can raise all types of emotions, like anxiety, feeling down, and just simply feeling overwhelmed. This is not to say that everyone who experiences these feelings has a diagnosis of depression or anxiety. More likely it is an adjustment period, which will get better with time and patience.

Are freshmen more vulnerable to experiencing high levels of stress and anxiety than upperclassmen?

Freshmen are not more vulnerable to high levels of stress than upperclassmen. They are, however, embarking on one of the bigger developmental jumps in life. It is not atypical for a freshman to experience mild levels of anxiety about the transition to college. Figuring out how to manage day-to-day obligations is a big task. Taking some time to write out a schedule mapping out classes and assigning time for socializing is often a helpful first step for freshmen who are feeling overwhelmed. Taking care of the basics helps to take care of the other details.

During later college years, searching for a job, thinking about graduate school, and leaving all the new friendships you worked so hard to create can also cause some worry. These are all normal and healthy things to be concerned about.

With the national Healthy Minds Study, which examines mental health and related issues—depression, anxiety, substance use—and use of services among college students, we have been able to get a sense of how BU students are doing. When surveyed two years ago, about 9 percent of our students reported that they had been unable to stop or control worrying nearly every day over the previous two weeks and 32 percent reported that they had been unable to stop or control worrying several days during that period. The good news is that over 44 percent of BU students reported that they experienced no problems stopping or controlling worrying.

Are freshmen more vulnerable to experiencing high levels of stress and anxiety than upperclassmen?

Most important, don’t get anxious about being anxious. Remind yourself that it can be normal, practice mindfulness, engage in an activity that makes you feel good, whether it’s exercise, community service, or a social activity. Keep in mind that this is a big time in life, with lots of changes, and feeling a bit overwhelmed is normal. Allow yourself to recognize that there are a lot of new demands and that you have always had others to help you manage, so realize that it can take some time to adjust. Stress or even mild anxiety has gotten a bad rap. It’s what keeps us motivated, lights a fire in us to pursue things, and reminds us to be aware of things in our life that may need some attention. It is when this stress becomes distress, whether as a freshman or as a senior, that one should reach out for help.

You mentioned sleep earlier. What is the role of adequate sleep in helping to reduce stress and anxiety?

Sleep plays a really important role in helping us manage stressors. It provides the opportunity for our body to shut down and reset, to shut off our thoughts and our muscle tensions. Sleep disruption affects our bodies on several levels, and it wreaks havoc in the brain, impairing thinking and emotional regulation. When we are tired, we are not firing on all cylinders, and this often makes smaller stressors, whether interpersonal or academic, feel much bigger. And not getting enough sleep is not remedied by a few cups of coffee. In fact, that exacerbates the issue by potentially increasing anxiety and may affect sleep for the next night. It’s also important to shut down electronics, like iPhones, computers, and iPads. Not only might you see a posting on Facebook that gets your mind going, but the light produced from these devices actually decreases our natural production of melatonin, a hormone that helps control our sleep and wake cycles.

What symptoms might suggest a student is experiencing something more serious than normal anxiety and stress?

Everyone manages the transition to college differently. Some hit the ground running. For others, a few growing pains may be experienced. When feelings like sadness, fear, social disinterest, or low motivation begin to affect a student’s ability to carry out the necessary steps to be successful, then it’s time to reach out for help. Never ignore a problem; both academic and emotional challenges are most successfully managed early, when small. If sleep is consistently disturbed because of anxiety or racing thoughts, if your mood is so low that your appetite is gone, or if getting out of bed feels like a struggle, there is cause for concern.

What resources are available on campus to students experiencing debilitating stress, anxiety, or depression?

Behavioral Medicine offers assessment and brief treatment for full-time students. Many of the freshmen who come to our office are experiencing the normal developmental hurdle of assimilating to a new place. One of the benefits in coming to such a large university is that there is access to a number of really great supports. Someone experiencing stressors related to academics may not need therapy and instead will be directed to the Educational Resource Center or encouraged to speak with their professor. Others who feel isolated or down may be experiencing homesickness: being directed to places like the Student Activities Office or the Community Service Center could help them establish a social group. When it is clear, based on our initial assessment, that mental health care is needed, we work with the student either on a short-term basis here at SHS, or if warranted, provide them with a referral for ongoing treatment.

Do you have specific tips about what parents can do long-distance to help their children handle stress and anxiety?

Normalize the stressors your child is experiencing. College is an exciting journey, filled with lots of changes and challenges. Navigating social, academic, and familial stressors is compounded by the basics of time management and figuring out how to get from one end of campus to the other. In general, don’t downplay how hard a transition this is. Encourage them to be patient. With a generation of students who expect immediacy, sometimes the biggest challenge is patience. Helping them to recognize that it takes time to establish a schedule, relationships, and a sense of security is a great place to start. Suggest that they make plans with roommates or floor-mates or explore the campus by seeking out clubs or activities. Remind them about things that felt secure in high school and how they can possibly replicate some of those things in their new home.

What signs indicating their student might be in trouble should parents be aware of?

A phone call or text from a child who is upset or anxious is difficult for any parent to experience. But sometimes the signs are less clear. While grades are a good indicator of academic success, they don’t capture the whole picture. Ask them if they are enjoying college and feeling connected. If parents see their child continuing to struggle beyond normal growing pains, it may be cause for concern. Pay specific attention if your child is socially withdrawing or communicating in a way that’s different from how they had previously. Don’t be alarmed at the first text that goes unanswered, as they may just be busy. But pay attention to other clues: a daughter who had been thriving academically, but is now struggling to pass or a son who was a social butterfly in high school and now eats alone can be indicators of distress.

Those interested in confidential assessment, short-term counseling, and/or medication management or referral for ongoing counseling in the community can contact Student Health Services Behavioral Medicine. Other resources available are the Danielsen Institute, the Center for Anxiety & Related Disorders, the Samaritans of Boston suicide hotline, and the Sexual Assault Response & Prevention Center.

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